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What does it mean to have a Catastrophic Impairment?

Wednesday, January 22, 2020

According to the Statutory Accident Benefits Schedule (“SABS”) – the no-fault auto accident insurance benefits are available to anyone injured in a car accident in Ontario, subject to certain limitations.

 

The “SABS” determines how much funding that is available to you for any medical rehabilitation treatment, based on the severity of your injuries using a three-tier guideline, that is as follows:

 

Minor Injury Guideline - individuals with “minor injuries” (defined as whiplash-related injuries, muscular strains/sprains, contusions and lacerations), this tier entitles an injured person to $3,500 for any medical rehabilitation treatment they require;

 

Non-Catastrophic Impairmentindividuals that have injuries and impairments, which neither fits the defined criteria for a minor injury or that of a catastrophic impairment. This tier provides up to $65,000 of medical-rehabilitation and attendant care funding, lasting up to five years;

 

Catastrophic Impairmentindividuals with an impairment that is a catastrophic impairment covers their medical-rehabilitation and attendant care needs, this tier funds up to $1 Million for their lifetime. Certain other benefits are also increased, extended or made available.

 

Catastrophic Impairment is determined if an insured person sustains the impairment in an accident that occurs on or after June 1, 2016 and the impairment results in any of the following:

 

  1. Paraplegia or tetraplegia that meets criteria;

 

  1. Severe impairment of ambulatory mobility or use of an arm, or amputation that meets includes specific criteria;

 

  1. Loss of vision of both eyes that meets specific criteria;

 

  1. Traumatic brain impairment is defined using specific criteria including the GOS-E for adults:
    1. Vegetative State one month after accident;
    2. Upper Severe Disability or Lower Severe Disability six months after accident;
    3. Lower Moderate Disability one year or more after accident and brain imaging.

 

  1. Traumatic brain impairment If the person is under 18 years of age: a traumatic brain injury, confirmed by medical imaging, and the person has been admitted into hospital or the person has severely impaired neurological functioning;

 

  1. A physical impairment or combination of physical impairments that result in a 55% or more physical impairment of the whole person using the AMA Guides, 4th edition;

 

  1. A mental or behavioural impairment, that meets criteria of the AMA Guides, 6th edition, when combined with a physical impairment, results in a 55% or more impairment of the whole person;

 

  1. An extreme impairment, in accordance with the AMA Guides, 4th edition that results in a class 4 (marked impairment) in three or more areas of function or a class 5 (extreme impairment) in one or more areas of function that precludes useful functioning, due to a mental or behavioural disorder.

 

The complete criteria can be found at section 3.1(1) of the SABS, legislation.

The above is a summary of the more in-depth explanation within in the SABS. Your health care provider will need to review the complete criteria before coming to a final opinion on whether you are deemed Catastrophically Impaired. Health care providers will often require specialized knowledge and familiarity with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, and an understanding of the Glascow Outcome Scale and the ASIA Impairment Scale.

 

To determine whether you have a catastrophic impairment, a form called an “Application for Determination of Catastrophic Impairment (OCF-19)” will need to be completed by a doctor and/or Neurologist (in case of brain injury) and submitted to your auto insurance adjuster.

 

In some cases, where your injuries are severe, such as paraplegic, amputee, or a child with a brain injury who has been admitted to hospital are automatically deemed Catastrophic once the OCF-19 is received. Other impairments may require a wait time of two (2) or more years before submitting an OCF-19. In most cases, insurance companies will require you to attend a series of medical assessment to assist in determining the criteria for catastrophic impairment is met according to the SABS.

 

However, if the medical assessments have denied that you are catastrophically impaired then you may dispute the decision with your own set of assessments and appeal the decision with an application through the Licence Appeal Tribunal (LAT) that will result in a hearing before an adjudicator. Your lawyer will present supporting evidence at the hearing and you will likely be examined by the insurance company’s lawyer, but the decision will be made by the adjudicator based on the criteria of “Catastrophic Impairment” as set out in s.3.1 of the SABS.

 

The process of determining whether you are catastrophically impaired may sound discouraging but It is important to note that the consequences of these impairments can be a life long battle, burdened by potentially financial and emotional stress. OHIP funded health care for people seriously injured in a car accident are minimal considering the amount of treatment you will likely need ranging from physiotherapy, psychology, occupational therapy, assistive devices, speech language pathology, and/or modifications to your home such as ramps and stair lifts. If you fit the criteria of one of the above-summarized categories for catastrophic impairment it will be a life long journey that could be a financial burden on you without the funding you could be entitled to receive.

 

If you have been seriously injured in a motor vehicle accident, we strongly recommend that you contact our highly experienced personal injury lawyers immediately to ensure your future is protected. At TS Law, there are no legal fees unless you win, and our experienced team of litigators will come to you, if necessary, for a free no obligation consultation, regardless if your injuries have you in the hospital or at home.

Call us today and get your life back on track! Call 905-777-0070 and speak to one of our qualified legal support team members to book your free initial consultation.                  

TS LAW = TRUSTED SUCCESS

What to know about your vehicle’s “black box data” recorder following a collision

Wednesday, October 30, 2019

It is important to know your rights if you are injured in an automobile accident, and the professionals the Stayshyn Law Offices are your best source to navigate you through a critical and complex process.

Most people do not know that their newly purchased automobile has a data recorder. These recorders, often referred to as “black boxes” record data such as speed, braking and other relevant vehicle data prior to and during an accident. This information can often be used to provide very important information about activities of each vehicle involved in a collision that witnesses are unable to recall. Therefore, the preservation of this data is very important. Most people don’t realize that when you are involved in a motor vehicle collision in which there are injuries, you should, after seeking medical treatment, immediately request that your insurer preserve your vehicle data recorder before the vehicle is repaired or sent to salvage. This collision data is often deleted or overwritten once repairs are made so it is very important that you or a family member request that the data and vehicle be preserved immediately. This information may prove critical to the resolution of who is at fault for the accident or substantiate the severity of your injuries.

When you choose Stayshyn Law Offices as your personal injury lawyers, you get experience you can trust and results you will appreciate. Our team offers a unique perspective and has an exceptional record for outstanding results. There are many practical incentives that make Stayshyn Law Offices a natural choice as your personal injury firm:

  • No legal fees unless you win
  • No obligation free initial consultation
  • Our lawyers will come to your home or hospital room, if necessary
  • Free parking available for all clients and consultations
  • Our team and staff will get you the best medical care
  • Friendly lawyers and legal support staff that are here to help you
  • Our lawyers and staff will help you assist you in completing all insurance forms
  • Our firm has successfully settled millions of dollars worth of injury claims

Call us today and get your life back on track! Call 905-777-0070 and speak to one of our qualified legal support team members to book your free initial consultation.

TS LAW = TRUSTED SUCCESS

Do you live with chronic pain as a result of a motor vehicle accident?

Wednesday, October 9, 2019

If you have been injured in a motor vehicle accident in Ontario, then you have access to treatment benefits from your own insurance company, called Accident Benefits. These benefits give you access to medical and rehabilitation treatment, lost income/wages, lost educational expenses if you are attending school, attendant care expenses, assistive devices, damaged clothing, if necessary.

You will also have a claim against the other driver that was at fault for the motor vehicle accident, but before you can pursue a claim, you must start a claim with your insurance company for accident benefits and attend treatment to reduce your losses. However, you will want to ensure that you are fully informed of your rights and treated fairly by your insurance company when submitting a claim for benefits. This proves to be challenging for some people, depending on your insurance company and/or the adjuster assigned to your file and the circumstances of your injuries.

Often, your insurance adjusters will dispute your injuries and send you to assessments by doctors that are hired by the insurance company to determine if you meet the legal tests before approval for said benefits is given.

There are 3 categories that you can fall under with respect to your injuries and impairments after a motor vehicle accident:

  1. Minor Injury Guideline;
  2. Medical & Rehabilitation; and
  3. Catastrophic.

Minor Injury Guideline

An important definition to note, is the Minor Injury Guideline: Limited to $3,500.00:

Minor Injury Guideline (MIG) -   one or more of a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and includes any clinical associated sequelae to such an injury.”

This is important because how you are placed in the 3 categories determines how much funding you have access to for treatment. Under Minor Injury Guideline you are limited to $3,500.00 for treatment, however outside of the MIG you have access to $65,000.00 in benefits.

If you suffer from chronic pain your injuries may hinder you from working and/or carrying on in your normal life and the funds provided in the minor injury guideline may not be adequate for the treatment you will require.

It is an insurance company’s position that if you have chronic pain as a result of the motor vehicle, but it is not diagnosed or determined until months after the motor vehicle accident, then you will essentially have to live with it, without access to treatment beyond the minor injury guideline. According to the insurance company “an insurer must look to initial injuries and diagnoses as indication of whether an insured’s injuries fall within the MIG.” 17-000835 v. Aviva General Insurance Canada, 2018 CanLII 83520 (ON LAT)

When you dispute the insurance company’s decision, the tribunal will review how your life has been impacted as a result of the motor vehicle accident along with the supporting medical evidence of your injuries to determine whether your chronic pain falls outside the Minor Injury Guideline.

This is why we highly recommend if you are a victim suffering from chronic pain injuries to contact our highly qualified personal injury lawyer, at TS law to properly assess your claim and injuries and take to appropriate steps to ensure you are getting treated fairly by your insurance company and getting access to the all the accident benefits you deserve.

If you have been seriously injured in a motor vehicle accident, we strongly recommend that you contact our highly experienced personal injury lawyers immediately to ensure your future is protected. At TS Law, there are no legal fees unless you win, and our experienced team of litigators will come to you, if necessary, for a free no obligation consultation, regardless if your injuries have you in the hospital or at home.

Call us today and get your life back on track! Call 905-777-0070 and speak to one of our qualified legal support team members to book your free initial consultation.                  

                                          TS LAW = TRUSTED SUCCESS

Do Liability Waivers Hold Up in Court?

Wednesday, September 4, 2019

Often, you will be required to sign a waiver before you or your child participate in sports, field trips, camps, and most recreational activities run by an individual or organization. The purpose is to protect the individual or organization from any and all liability in the event that you or your child is hurt while participating in said activity.

Liability waivers have become so common that most people do not review or even consider waivers before signing them.

A standard liability waiver is in place to protect the individual or organization from any legal action if you or your child becomes injured at their establishment. These waivers are intended to be legally binding contracts that essentially waive your right to sue, even due to negligence of the individual or organization running the activity. Over the years, courts have made a wide-ranging of decisions on whether liability waivers are legitimate and enforceable. Currently in Ontario, a standard liability waiver is typically upheld in courts, according to the law.

Generally, a liability waiver can be relied upon for any injuries sustained with respect to the actual activity but not for injuries that occur on the property unrelated to the activity; such as, if you or your child slip and fall on ice in the parking lot.

Just remember, the individual or organization needs to take the necessary step to bring the waiver to your attention prior to the activity along with sufficient time to review and sign the waiver. That being said, the enforceability of a waiver is not clear cut and if you are uncertain if the waiver applies to you with respect to an injury, we strongly recommend that you contact our highly experienced personal injury lawyers immediately to ensure your future is protected. At TS Law, there are no legal fees unless you win, and our experienced team of litigators will come to you, if necessary, for a free no obligation consultation, regardless if your injuries have you in the hospital or at home.

Call us today and get your life back on track! Call 905-777-0070 and speak to one of our qualified legal support team members to book your free initial consultation.                  

TS LAW = TRUSTED SUCCESS